Rep. Upmeyer: Oversight and accountability for Medicaid

The following is a legislative update from Rep. Linda Upmeyer of Clear Lake:

We just wrapped up second funnel, where policy bills that came over from the Senate are required to be approved by at least one House committee to remain eligible for consideration this session. With the second funnel come and gone, we have a much smaller list of bills that still need to be acted on and work on next year’s budget will soon come into full focus.

In 2016, Iowa transitioned its Medicaid program to a managed care model. This was an important step to ensure more predictability in the state’s budget while also protecting the sustainability of the Medicaid program. Additionally, managed care focuses on wellness of the patient to keep people healthy, rather than treating illnesses as the arise.

However, both Medicaid members and providers have had challenges navigating the new managed care system, delayed payments, communicating with the managed care organizations (MCOs), and getting the right care.

Last week, the House passed legislation that addresses these issues and should smooth out some of the bumps that system has encountered since the transition to managed care. This will make the system work better for both Medicaid members and providers, and hold the MCOs accountable.

Here are some of the ways this bill will improve our Medicaid system:

Holding MCOs Accountable to Providers:
Requires MCOs to pay providers in a timely manner and provide justification for denying a claim
Requires evaluation of all prior authorization requirements by MCOs
Requires a uniform credentialing process between all MCOs
Requires mental health and substance abuse services to be paid for court committed individuals
Holding MCOs Accountable to Members:
Requires the state to review any decrease in level of care for a member by an MCO
Extends services for a member that has won on appeal against an MCO
Requires an evaluation of health home services with providers and the MCOs
Stronger Oversight of the Medicaid System:
Requires the state to update Medicaid eligibility files promptly to provide notice to providers
Requires an audit of claims paid or denied by MCOs
The bill is now in the Senate, and I am anxiously awaiting their action.

These are much-needed changes that will improve our system and make it work better for those that it serves. I’m optimistic that we will soon turn a corner and have an effective, efficient Medicaid system for those that count on it.

The Department of Human Services (DHS) has also taken steps on their own to get things working properly. They have established a working group that brings DHS officials and providers together to fix some of the problems that the system is facing. We also have a new actuary, so we can ensure appropriate resources are provided to the Medicaid program. Additionally, we have new leadership at DHS with Director Jerry Foxhoven, and a new Medicaid Director.

Governor Reynolds reached across the aisle when she first appointed Director Foxhoven, and he was widely praised by folks from both parties. Unfortunately, it seems that election year politics have gotten in the way, and his confirmation is now at risk in the Senate. It seems as though some people would rather have a talking point for an election than a properly functioning Medicaid program, which is disappointing. I’m hopeful that Senators will put aside the partisan politics and confirm Director Foxhoven. He is highly qualified for the job and knows what needs to be done to fix the Medicaid program.

If you are a Medicaid provider or member and are having issues navigating the system, please don’t hesitate to reach out to me. I am happy to be helpful in any way I can.